Subdivision 1. Application.
The definitions in this section apply to this chapter.
Subd. 2. Activities of daily living.
"Activities of daily living" means eating, toileting,
transferring, bathing, dressing, and continence.
Subd. 3. Acute condition.
"Acute condition" means that the individual is medically unstable
and requires frequent monitoring by medical professionals, such as physicians and registered
nurses, in order to maintain the individual's health status.
Subd. 4. Adult day care.
"Adult day care" means a program for six or more individuals of
social and health-related services provided during the day in a community group setting for the
purpose of supporting frail, impaired elderly, or other disabled adults who can benefit from care in
a group setting outside the home.
Subd. 5. Applicant.
(1) in the case of an individual long-term care insurance policy, the person who seeks to
contract for benefits; or
(2) in the case of a group long-term care insurance policy, the proposed certificate holder.
Subd. 6. Bathing.
"Bathing" means washing oneself by sponge bath; or in either a tub or
shower, including the task of getting into or out of the tub or shower.
Subd. 7. Certificate.
"Certificate" means a certificate issued under a group long-term care
insurance policy delivered or issued for delivery in this state.
Subd. 8. Chronically ill individual.
"Chronically ill individual" means an individual who
has been certified by a licensed health care practitioner, within the preceding 12-month period,
(1) being unable to perform, without substantial assistance from another individual, at least
two activities of daily living for a period of at least 90 days due to a loss of functional capacity; or
(2) requiring substantial supervision to protect the individual from threats to health and
safety due to severe cognitive impairment.
Subd. 9. Cognitive impairment.
"Cognitive impairment" means a deficiency in a person's
short or long-term memory, orientation as a person, place and time, deductive or abstract
reasoning, or judgment as it relates to safety awareness.
Subd. 10. Commissioner.
"Commissioner" means the commissioner of commerce.
Subd. 11. Continence.
"Continence" means the ability to maintain control of bowel and
bladder function, or when unable to maintain control of bowel or bladder function, the ability to
perform associated personal hygiene, including caring for catheter or colostomy bag.
Subd. 12. Dressing.
"Dressing" means putting on and taking off all items of clothing and any
necessary braces, fasteners, or artificial limbs.
Subd. 13. Eating.
"Eating" means feeding oneself by getting food into the body from a
receptacle, such as a plate, cup, or table, or by a feeding tube or intravenously.
Subd. 13a. Exceptional increase.
(a) "Exceptional increase" means only those premium
rate increases filed by an insurer as exceptional for which the commissioner determines that the
need for the premium rate increase is justified due to changes in laws or rules applicable to
long-term care coverage in this state, or due to increased and unexpected utilization that affects
the majority of insurers of similar products.
(b) Except as provided in section
, exceptional increases are subject to the same
requirements as other premium rate schedule increases. The commissioner may request a review
by an independent actuary or a professional actuarial body of the basis for a request that an
increase be considered an exceptional increase. The commissioner, in determining that the
necessary basis for an exceptional increase exists, shall also determine any potential offsets to
higher claims costs.
Subd. 14. Loss of functional capacity.
"Loss of functional capacity" means requiring the
substantial assistance of another person to perform the prescribed activities of daily living.
Subd. 15. Group long-term care insurance.
"Group long-term care insurance" means a
long-term care insurance policy delivered or issued for delivery in this state and issued to:
(1) one or more employers or labor organizations, or to a trust or to the trustees of a fund
established by one or more employers or labor organizations, or a combination, for employees
or former employees, or a combination, or for members or former members, or a combination,
of the labor organizations;
(2) a professional, trade, or occupational association for its members or former or retired
members, or combination, if the association:
(i) is composed of individuals, all of whom are or were actively engaged in the same
profession, trade, or occupation; and
(ii) has been maintained in good faith for purposes other than obtaining insurance;
(3) an association or a trust or the trustee of a fund established, created, or maintained for the
benefit of members of one or more associations. Before advertising, marketing, or offering the
policy within this state, the association or the insurer of the association must file evidence with
the commissioner that the association has at the outset a minimum of 100 persons and has been
organized and maintained in good faith for purposes other than that of obtaining insurance; has
been in active existence for at least one year; and has a constitution and bylaws that provide that:
(i) the association holds regular meetings not less than annually to further purposes of the
(ii) except for credit unions, the association collects dues or solicits contributions from
(iii) the members have voting privileges and representation on the governing board and
Thirty days after the filing, the association is considered to have satisfied the organizational
requirements, unless the commissioner makes a finding that the association does not satisfy
the organizational requirements; or
(4) a group other than as described in clauses (1) to (3), subject to a finding by the
(i) the issuance of the group policy is not contrary to the best interest of the public;
(ii) the issuance of the group policy would result in economies of acquisition or
(iii) the benefits are reasonable in relation to the premiums charged.
Subd. 16. Guaranteed renewable.
"Guaranteed renewable" means the insured has the
right to continue the long-term care insurance in force by the timely payment of premiums and
the insurer has no unilateral right to make any change in any provision of the policy or rider
while the insurance is in force and cannot decline to renew, except that rates may be revised by
the insurer on a class basis.
Subd. 17. Home health care services.
"Home health care services" means medical and
nonmedical services provided to ill, disabled, or infirm persons in their residences. The services
may include homemaker services, assistance with activities of daily living, and respite care
Subd. 17a. Incidental.
"Incidental," as used in section
62S.265, subdivision 10
, means that
the value of the long-term care benefits provided is less than ten percent of the total value of the
benefits provided over the life of the policy. These values must be measured as of the date of issue.
Subd. 18. Long-term care insurance.
"Long-term care insurance" means a qualified
long-term care insurance policy or rider advertised, marketed, offered, or designed to provide
coverage for not less than 12 consecutive months for each covered person on an expense incurred,
indemnity, prepaid, or other basis for one or more necessary or medically necessary diagnostic,
preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a
setting other than an acute care unit of a hospital. Long-term care insurance includes:
(1) group and individual annuities and life insurance policies or riders that provide directly
or that supplement long-term care insurance; and
(2) a policy or rider that provides for payment of benefits based upon cognitive impairment
or the loss of functional capacity.
Long-term care insurance does not include an insurance policy that is offered primarily to provide
basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical
expense coverage, hospital confinement indemnity coverage, major medical expense coverage,
disability income or related asset-protection coverage, accident only coverage, specified disease
or specified accident coverage, or limited benefit health coverage. With regard to life insurance,
long-term care insurance does not include life insurance policies that accelerate the death benefit
specifically for one or more of the qualifying events of terminal illness, medical conditions
requiring extraordinary medical intervention, or permanent institutional confinement, and that
provide the option of a lump-sum payment for those benefits and in which neither the benefits nor
the eligibility for the benefits is conditioned upon the receipt of long-term care.
Subd. 19. Maintenance or personal care services.
"Maintenance" or "personal care
services" means any care the primary purpose of which is the provision of needed assistance with
any of the disabilities as a result of which the individual is a chronically ill individual, including
the protection from threats to health and safety due to severe cognitive impairment.
Subd. 20. Medicare.
"Medicare" means The Health Insurance for the Aged Act, Title XVIII
of the Social Security Amendments of 1965, as amended, or Title I, Part I, of Public Law 89-97,
as Enacted by the Eighty-Ninth Congress of the United States of America, as amended.
Subd. 21. Mental or nervous disorder.
"Mental or nervous disorder" means a neurosis,
psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.
Subd. 22. Noncancelable.
"Noncancelable" may be used only when the insured has the right
to continue the long-term care insurance in force by the timely payment of premiums during
which period the insurer has no right to unilaterally make any change in any provision of the
insurance or in the premium rate.
Subd. 23. Policy.
"Policy" means a policy, contract, subscriber agreement, rider, or
endorsement delivered or issued for delivery in this state by an insurer; fraternal benefit society;
nonprofit health, hospital, or medical service corporation; prepaid health plan; health maintenance
organization; or a similar organization.
Subd. 23a. Qualified actuary.
"Qualified actuary" means a member in good standing of the
American Academy of Actuaries.
Subd. 24. Qualified long-term care insurance policy.
"Qualified long-term care insurance
policy" means a policy that meets the requirements of Section 7702(B) of the Internal Revenue
Code, as amended, and this chapter.
Subd. 25. Qualified long-term care services.
"Qualified long-term care services" means
necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, and rehabilitative
services and maintenance or personal care services, which are:
(1) required by a chronically ill individual; and
(2) provided pursuant to a plan of care prescribed by a licensed health care practitioner.
Subd. 25a. Similar policy forms.
"Similar policy forms" means all of the long-term care
insurance policies and certificates issued by an insurer in the same long-term care benefit
classification as the policy form being considered. Certificates of groups that meet the definition
62S.01, subdivision 15
, clause (1), are not considered similar to certificates or policies
otherwise issued as long-term care insurance, but are similar to other comparable certificates with
the same long-term care benefit classifications. For purposes of determining similar policy forms,
long-term care benefit classifications are defined as follows: institutional long-term care benefits
only, noninstitutional long-term care benefits only, or comprehensive long-term care benefits.
Subd. 26. Toileting.
"Toileting" means getting to and from the toilet, getting on and off the
toilet, and performing associated personal hygiene.
Subd. 27. Transferring.
"Transferring" means moving into or out of a bed, chair, or
History: 1997 c 71 art 1 s 1; 1998 c 328 s 4; 1999 c 177 s 59; 1Sp2001 c 9 art 8 s 4-7;
2002 c 379 art 1 s 113